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Fever in a Teen*

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History of Present Illness:

A 16-year-old female presents to the ED for 3 days of vomiting and tactile fevers.    She denies any abdominal or flank pain, dysuria or diarrhea.  She had a mild headache a few days ago, but it went away.  When specifically asked, she does admit to a slight cough.  She denies any recent travel, injection drug abuse or dental work.

Vital Signs & Physical Exam:

Vital signs are normal except for a temp of 100.3 and a pulse of 133.  Physical exam is otherwise normal with no rash, tonsilar exudate, rales, murmur, flank tenderness or other abnormality

Initial Differential Diagnosis: pyelo, pneumonia, viral syndrome, meningitis

Relevant Test Results:

  • EKG: none
  • Labs: WBC 19K, UA WNL, BMP WNL
  • Imaging: See below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows subtle bilateral interstitial infiltrates
  2. What should you do next?  Treat with ABX, steroids and admit.  Ask about vaping.  For references, see below
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  Repeat CXR the next day shown below

ARDS from vaping

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: Gradually became more hypoxic.  Was admitted to a step-down unit.  CT showed bilateral ground glass opacities.

References:

  1. Steroids for pneumonia: click here PRACTICE CHANGERS then scroll down to pulmonary section
  2. Vaping Associated Pulmonary Injury: https://emcrit.org/ibcc/vaping-associated-pulmonary-injury/
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